原发性脑室出血并全脑室铸型的手术治疗体会

目的探讨原发性脑室内出血全脑室铸型的手术治疗效果以及注意事项。方法随机选取我院神经外科原发性脑室内出血全脑室铸型患者48例,其中29例行开颅右额叶皮质造瘘,显微镜下清除侧脑室血肿减压(A组),19例采用双侧侧脑室钻孔引流血性脑脊液(B组)。术后两组均行脑室外引流+尿激酶脑室内注射治疗,术后治疗随访3个月,观察疗效及预后。结果 A组术后恢复良好15例,好转10例,死亡4例;颅内感染3例,癫痫3例,无脑积水患者;GOS评分:5分2例,4分13例,3分7例,2分3例,1分4例;救治成功率86%。B组术后恢复良好1例,好转10例,死亡8例;颅内感染4例,癫痫2例,脑积水5例;GOS评分:5分0例,4分1例,3分5例,2分5例,1分8例;救治成功率57.8%。两组GOS评分差异有统计学意义(P<0.05)。结论经额叶造瘘脑室血肿清除术加术后引流是抢救治疗急性脑室内出血并全脑室铸型的有力方式。

Surgical Treatment of Primary Intraventricular Hemorrhage with Total Ventricular Casting

Objective To investigate the effect of surgical treatment and the points for attention of primary intraventricular hemorrhage with casting of the whole ventricle.Methods 48 cases of primary intraventricular hemorrhage and casting of the whole ventricle in department of neurosurgery in our hospital were randomly selected.Among them,29 cases underwent craniotomy with right frontal cortex fistula,and the lateral ventricle hematoma decompression was performed under microscope(group A); 19 cases were treated with bilateral lateral ventricle drilling and drainage of hemorrhagic cerebrospinal fluid(group B); The two groups were treated with intraventricular drainage and intraventricular injection of urokinase,followed up for 3 months,and the curative effect and prognosis were observed.Results In group A,15 cases had good postoperative recovery,10 casesimproved,4 casesdied; There were 3 cases of intracranial infection,3 cases of epilepsy and 0 case of hydrocephalus; GOS score: 5 points in 2 cases,4 points in 13 cases,3 points in 7 cases,2 points in 3 cases,1 point in 4 cases; The success rate of treatment was 86%.While in group B,1 case had good postoperative recovery,10 cases improved,8 cases died; There were 4 cases of intracranial infection,2 cases of epilepsy and 5 cases of hydrocephalus; GOS score: 5 points in 0 case,4 points in 1 case,3 points in 5 cases,2 points in 5 cases,1 point in8 cases; The success rate of treatment was57.8%.SPSS 24 was used to analyze the data,and the difference was statistically significant(P<0.05).Conclusion It is a powerful way to rescue the acute intraventricular hemorrhage and cast the whole ventricular cavity by frontal lobe ostomy,hematoma evacuation and postoperative drainage.